HomeMy WebLinkAbout23-13230 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
CASE 23-13230 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 11 - 15 - 2023 1545 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINER AVE S BLOCK NO. e✓ 73
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e AIRPORT WAY S
0 4 29
UNIT
MOTOR Z PEDAL- ❑CYCLE DAMAGE NHORESHOLD MET PHONE 0 1 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑
NEW ADDRESS CITY SEATTLE ST ZIP z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8 DRIVER'S. STATE SEX.U D.Q.B. 1 1 2 32
❑ :LICENSE# MMDDYY —=
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10[ PI ATE#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR 5 7. TRLR 33
12 25 VIN If' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 34
13 4 KWMC NINJA MT DAMAGE YES No OV8 No
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VEwcLe 1 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069460248
16 a
LAST NAME REX FIRST NAME TIMOTHY MIDDLE W
INITIAL
17 STREET I❑ 5TH AVE S CITY' SEATTLE ST' WA ZIP 98178 37
NEW ADOREs�' 11546 8
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t l YES NO�
19 LDIIVEW # STATE WA SEX U M .C.B. 05 _ 07 1975 El 39
WELMET INJURY NATURE OF INJURIES 40
20� ON DUTY STATUS AIRBAG,2 RESTR 13 EJECT 2 USE 9 CLASS 5 BROKEN COLLAR BONE
❑21❑ PLATE# 8J7564 TATe WA VIN# VBKTU9403NM829563 41
4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE KTM MODEL 890 STYLE MT VEHICLE TOWED TO BLIN TOWEDev GOB HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO TIMOTHY REX 1154685TH AVE S SEATTLEWA98178 D:2069460248 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POLICY#E CO UNKNOWN UNKNOWNIN STOP 5
—'CLE ES❑ N J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY Y
25 s � a
7SHA
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 CROW 12618 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE23331
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13230
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SHAWN CROW 11-21-23 08:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 11/26/2023 8:49:26 AM
BADGE OR ID# 12618 OR]# WA0171300 TIME POLICE DISPATCHED, 7:24 AM TIME POLICE ARRIVED',7:Y7 AM
PART I PAGE IT]OF 4�
REPORT NO. EE23331 CASE# 23-13230 OF COLLISION
11/15/23 15:45
OF CbLLI510N
NARRATIVE
On 11/16/2023 at about 0727 hours I was working uniform marked patrol as 1 R15 when I was
dispatched to take a report by phone of an injury motorcycle versus motorcycle collision that occurred
the previous night. The collision occurred on Rainier Ave S in front of the Mcdonald's located at 73
Rainier Ave S within the city limits of Renton, King County, Washington.
On 11/15/2023 at approximately 1545 hours Timothy W. Rex (Driver 2) was driving his 2022 KTM
890 motorcycle (Unit 2) southbound in the outer lane of Rainier Ave S. Timothy was passing by the
Mcdonald's (73 Rainier Ave S) when another motorcycle (Unit 1) headed northbound on Rainier Ave
S suddenly made a left turn (west) toward the driveway of the McDonald's. Unit 2 was unable to stop,
and the front end of Unit 2 struck the right side of Unit 1. Both motorcyclists were ejected from their
motorcycles. The unidentified driver of Unit 1 (Driver 1) told Timothy that he had to leave before the
police arrived. Driver 1 then got back onto his motorcycle and drove off without making any attempt
to give Timothy his name or insurance information.
Timothy's bike had front end damage including a broken headlight and a broken shifter; however, he
was able to drive it home. Timothy had to get to a friend's house, but later decided to get into his
pickup truck and drive himself to the police station to report the collision. I spoke to Timothy at the
parking lot outside Renton City Hall on 11/15/2023, and he had an injury to his collar bone as a result
of the collision. The Renton Fire Department (RFD) was requested to the parking lot to evaluate
Timothy. After evaluating Timothy the RFD transported him to Valley Medical Center for his collar
bone injury. Due to the extent of Timothy's injuries I told him that an officer would be in contact with
him to gather further information regarding the collision. I relayed the information to dispatch, but
Timothy did not answer his phone when an attempt was made to contact him later that evening by
another officer.
Timothy called 911 the following morning at about 0724 hours to finish giving officers information for
the collision report. He mentioned that his cellphone was turned off while at the hospital the previous
night which was why officers were unable to contact him. Timothy received X-rays while at the
hospital, and he was informed by hospital staff that his collar bone was broken. Timothy did not
report any other injuries.
Timothy described Driver 1 as a white male, about 30 years of age, about 5'-08" in height, about 150
pounds, "cross eyed", excessive acne on his face, red colored patchy beard, medium build, and wore
a black colored helmet with a broken visor.
Timothy described Unit 1 as a mid 2000s Kawasaki Ninja 250 motorcycle, blue and black in color, no
license plate with a broken windshield and broken fairings on the right side.
The identity of Driver 1 is unknown at this time.
PAGE 3 OF 4
REPORT NO. EE23331 CASE# ' 23-13230 DATE AND TIME 11/15/23 15:45
OF COLLISION
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PAGE 4 OF 4
